FAQ Category: Lumbar Spine

Steroid injection has some possible problems. It’s still less risky than surgery. Some doctors advise trying up to three injections before going to surgery. Some patients get
better after only one injection.

Some studies show injection or surgery works best when 25 percent or more of the disc is pressing into the spinal canal. Less than 25 percent usually gets better with nonoperative treatment. Anti-inflammatory drugs, physical therapy, and exercise should be
tried first.

If the injection doesn’t work, you can always have the discectomy. Research shows delaying a discectomy doesn’t affect the results. Likewise, having a steroid injection first doesn’t seem to affect results later after a discectomy.

You may be referring to an injection given into the epidural space around the spinal cord. A local anesthetic combined with a narcotic is used for pain control. The doctor uses a needle inserted into the epidural space to put the drug in effect.

There may not be any space open for the needle to enter if there is a lot of inflammation and swelling in the area. Sometimes the needle is too large for the patient’s anatomy preventing entry. The doctor can tell if the needle is in the right place. A special test
called the whoosh test is used.

Air is injected through the needle into the space before the drug is used. The doctor listens to the spine with a stethoscope. If the needle is in the right place, the sound of air will be heard. The doctor can also use imaging X-rays to show the placement of the needle.

The first thing is to find out what’s causing the sciatica. Infection, disc disease, or tumor are just a few things that can put pressure on the sciatic nerve. Treatment works
best when directly specifically at a known cause.

Doctors often start out with pain relievers that also act as an antiinflammatory. This includes ibuprofen, aspirin, and other non-steroidal antiinflammatories. Physical therapy can help if there’s a muscle or joint imbalance putting pressure on the nerve.

If conservative measures don’t help then your doctor may advise surgery. Again this depends on the underlying cause of the problem. For example, a disc pressing on the nerve can be removed. In such cases, pain relief can be immediate.

Studies show many different kinds of people with various jobs develop a disc problem. Most are involved with heavy-duty work, but some have light-duty work or are students or
retired.

Heavy lifting and repetitive movements put a person at increased risk of back injury. Smoking or tobacco use are also linked with low back pain. Aging with disc degeneration
is also a risk factor.

Even though your situation seems like it happened all of a sudden, it’s likely that a gradual process of disc degeneration has been taking place over time. An old injury, poor posture, or large abdomen adds stress and strain to an already aging body part.

There is a link between smoking and low back pain (LBP). This makes smoking a risk factor for LBP, but not the actual cause.

Most of the research shows indirect links. For example smoking can lead to chronic coughing which may be linked with back pain. Smokers tend to have other poor health habits. They may be inactive, overweight, and at risk for brittle bones (osteoporosis). Osteoporosis increases the risk of bone fracture.

A recent study compared muscle strength in smokers versus nonsmokers. There were two groups of each: those with back pain and those without back pain. In general, smokers have less lumbar muscle strength. This is true whether or not they have back pain.

Some studies support a link between cigarette smoking and decreased bone density. Less bone puts the spine at risk for fracture and back pain. Exercise has clearly been shown
to make a difference. You may not gain back bone mass lost, but you are more likely to keep what you have.

A new study shows smokers tend to have weaker back extensor muscles than nonsmokers. Smokers with back pain and without back pain were compared. They had about the same amount of muscle weakness. Even nonsmokers with back pain had greater strength than any smoker.

All in all it looks like exercise is the best medicine for many problems including osteoporosis. However, the benefit of exercise while still smoking has not been studied.

Your doctor has given you good advice. Nicotine in cigarettes closes down the blood vessels. This is called vasoconstriction. The result is a loss of oxygen and nutrition to the back. This includes muscles, tendons, ligaments, bones, and discs.

The risk of disc problems is increased in smokers. Smokers tend to have disc problems throughout the spine, not just at one or two levels. Some studies show that the number of cigarettes smoked each day does make a difference.

Quitting tobacco use is the best for your overall health, not just to reduce back pain. If you can’t quit then cutting back as much as possible is the next best step.

A recent study in Canada looked at this question as part of their ongoing research. They found more people went back to work after disc removal if they were still at work before the surgery. They may have taken some time off for recovery, but all but one was able to return to work after the operation.

This study also showed patients who had the operation sooner than later had a better result. Physical function was worse in patients who waited more than 12 months to have the operation. This was compared with patients who had the surgery within the first three months of symptom onset.

One other factor in the return to work equation is complications. Poor health, continued back and leg pain, infection, or poor wound healing can keep a patient from getting back to work. In some cases, the job is too hard and retraining is needed.

In general, this is true. Patients are not treated on a first-come, first-served basis. They are seen based on how serious the condition is or how sick they are.

With limited funding, many operations are considered “elective” and not required. The patient can wait to reach the top of the waiting list for this operation, or he or she can go outside the system and pay for it privately.

A recent study on lumbar disc removal called discectomy from Canada reports rates for this operation. The reported rate of discectomy in the United States is 70 out of every 100,000. The rate is only 24 per 100,000 in Canada.

Artificial discs or disk implants have been around since the early 1950s. Today’s more modern technology has allowed scientists to improve the disc replacement.

Today’s disc implants are made of a plastic center with a metal back. Spine surgeons in Europe are starting to report their results from using this generation of implants over the last 10 years.

Researchers have found that the real disc takes the load around the edges of the
endplate, rather than through the center. They’ve tried to mimic this with the artificial implant. The goal is to match the implant to the bone as much as possible. This allows load around the edges and movement through the center at the same time.

As more is found out about how the natural disc works, the artificial disc will change and improve to match it. Its use will probably become more common in the years ahead.

Good question. The medical world doesn’t usually offer guarantees of any kind. In fact before any operation the patient gets a list of all the things that can go wrong and has to sign it to show understanding and agreement.

In 1999 the Texas Health Research Institute reported disc implants last 10- to 12-years in about 63 percent of the disc replacement patients. The problem is knowing which patients will fall into that group and whether you’ll be one of them.

Studies show patient selection for this operation is important. Younger patients with only one disc level involved have the best result. There has to be enough disc space left to let the doctor insert the implant in place. There’s a tendency to stretch the bones
too far apart when the disc space is too narrow. This can cause chronic pain from nerve damage.

Success is measured in different ways by different patients. Some say pain relief is all that’s needed. Others expect pain relief and return to full function. Return to work is a big goal for many patients. Guaranteeing implant success just isn’t possible at this time. As implants improve in design and function, we can expect to see better results.

Leg pain after artificial disc implantation isn’t reported much, but it’s fairly common. Doctors suggest the cause is over-distraction of the vertebral bones when inserting the
implant.

The bones can handle the stretch, but the nerves can’t. In the process, the spinal nerve roots get stretched setting off painful signals that may not go away. The doctor must choose just the right patients for this operation. Age, bone quality, and amount of disc
space are all important factors.

This operation takes a skilled surgeon with technical experience. He or she must be able to place the disc exactly in place with just the right amount of tension on the bones.

Analgesia is a medical term for pain relief. Stopping pain before it starts is the idea behind preemptive analgesia. In the case of back surgery, this can be done with a single injection of a narcotic mixed with a local anesthetic. It’s injected into
the epidural space around the spinal cord.

Patients still have some pain, but less than if the pain stimulus was allowed to set off the nervous system. The patient won’t be completely numb during the first 24 hours after the operation. Any problems that occur will still cause increased pain and symptoms the patient can report.

Preemptive analgesia is a way to inject a numbing painkiller into the epidural space around the spinal cord. The patient must be lying face down for this operation. The injection is given at least 20 minutes before the first incision.

It works by allowing local pain killing agents to lock onto the spinal nerve roots. The nerve roots normally signal the spinal cord. The spinal cord then signals the brain about
any problems. However the nervous system is very plastic or changeable. This means that pain signals can get blown out of proportion, leaving the patient with much more pain than is warranted by the condition. Once the signal gets turned on, it’s hard to turn it off.

Doctors can “preempt” severe pain by attaching a local anesthetic to the spinal nerves before pain signals ever get started. The patient still has some pain as a protective mechanism, but not the intense, prolonged pain allowed by central nervous system plasticity.

Ultrasound (US) can be a very effective method of heating deep tissues. Heat from the US
promotes relaxation and improves circulation. Pain relief is often a result of both.

Standard US is applied with an applicator called a soundhead. The soundhead is moved slowly in small circles. Each circle overlaps the last one. A five-minute treatment
is about right for a patch of skin two to three times the size of the soundhead. This gives the tissue underneath time to heat up.

Treating the entire low back area in five minutes is not effective. Be sure and ask your therapist about the treatment. Report your lack of progress, but give it some time. It may take three to five sessions to feel a difference.

A positive attitude and desire to get well are always helpful. Good nutrition is needed to help the body heal. Use of tobacco products is known to delay or reduce bone healing.

If you smoke or use any tobacco products, talk to your doctor about quitting before the operation. There are many programs to help you with this.

Studies also show the use of NSAIDs prevents bone fusion. NSAIDs are nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen. They are used to reduce pain and swelling. If you have problems with pain after the operation, talk to your doctor about other ways to control this pain in order to promote healing.

Follow your doctor’s guidelines about rest, physical activity, and exercise. This is an important part of the recovery process.

Your doctor would be the best one to answer this question with your specific situation in mind. It may depend somewhat on your general health, the type of surgery done, and the kind of work you do.

Many doctors suggest a two week wait before returning to light-duty work. Four to six weeks is more appropriate for heavy-duty work or vigorous activity. A low back corset may be advised during the early weeks of recovery. This can help unload the spine slightly and give you reminders about your restrictions. It can also help remind you to keep good posture.

Riding a motorcycle is also a matter for your doctor’s consideration. The main concerns are bumpy roads and hitting pot holes. The sudden unprotected motion can put pressure through the healing spine. You’ll most likely want to wait the full six weeks before any long distance travel.

Doctors and therapists know that back pain lasting more than six to eight weeks involves more than just pathology or tissue disease. Something has gone wrong with the pain signals. Studies show the nervous system has a memory and may be keeping the memory of
the pain alive longer than needed.

Pain that lasts more than three months is called chronic pain. Patients with chronic back pain are advised to regain as much movement, strength, and function as possible despite the pain. The symptom intensity should not be what limits your exercise progression.

For patients with chronic pain reducing pain isn’t the goal of treatment. Being more active and increasing function is the primary goal.

Radiofrequency (RF) is a form of heat energy used to stop nerve messages from reaching the joint. It has a low rate of complications and can be used at more than one level.

Most patients have half dozen areas heated during the same treatment. Repeating RF treatment to the same area may be needed if the nerve is not completely disabled. A second procedure to heat new levels is possible.

The doctor will use low voltage electrical stimulation to the area first. This confirms that there’s a problem and the exact location.

Hands and knees balance exercises are among the core exercises for spinal stability. These exercises are considered core for two reasons. They are central to the program and
also work on the core muscles that provide a stable spine during all postures and movement.

Scientists think that different muscles have different jobs. Some are lcoal muscles. These hold or stabilize the spine in one place. Other muscles are global.
This means they function to produce movement. There’s ongoing debate among researchers about which muscles are the most important for each function. The best way to train the motor control system is also being studied.

For now, we know the standard quadruped (on hands and knees) exercises help strengthen the local muscles for control and stability. Doing them properly is probably more important than doing them every day. If possible, use a mirror to watch your posture. Keep your low back and pelvis level. One side shouldn’t be higher than the other.

Tighten your abdominal muscles and hold your stomach in without holding your breath. Don’t scrunch your shoulders up around your ears. Keep them down while stretching the arm
forward. Avoid tension on your neck by keeping your gaze either down at the floor or just a little ahead of your body.

These exercises are hard to do. The body gets tired easily in these stable core positions. That’s why they work well to help the spine hold and why they are important to keep in the program.